Healthcare Provider Details

I. General information

NPI: 1275598708
Provider Name (Legal Business Name): DONALD WILLIAM DURRANCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH ASHLEY DRIVE SUITE 1500
TAMPA FL
33602-5318
US

IV. Provider business mailing address

100 SOUTH ASHLEY DRIVE SUITE 1500
TAMPA FL
33602-5318
US

V. Phone/Fax

Practice location:
  • Phone: 813-899-6220
  • Fax: 813-985-8006
Mailing address:
  • Phone: 813-899-6220
  • Fax: 813-985-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME 49786
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME49786
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: